Recurrent pyogenic cholangitis in a white woman.
Bibliographic record
Abstract
A healthy 68-year-old white woman of eastern European origin who had lived her entire life in Canada presented with ascending cholangitis. She had undergone cholecystectomy many years earlier and had suffered recurrent bouts of abdominal pain over the last few years, for which multiple investigations demonstrated only common bile duct (CBD) dilatation without a clear etiology. CT of the abdomen (Fig. 1) now showed dilated left-sided central intrahepatic bile duct, and endoscopic retrograde cholangiopancreatography (ERCP) confirmed the presence of multiple small stones in those segments. A diagnosis of recurrent pyogenic cholangitis (RPC) was made. Because the large number of stones could not all be retrieved by ERCP and because of the recurrent nature of her disease, surgical management was indicated. FIG. 1. CT scan of the abdomen demonstrating left-sided dilatation of the central intrahepatic bile duct. The patient underwent a left hepatectomy. Multiple, small, friable, pigmented stones were found in the left intrahepatic bile ducts; intraoperative choledochoscopy confirmed the absence of any disease in the right biliary tree. A Roux-en-Y hepaticojejunostomy was performed with pexy of the blind-ended limb to the anterior abdominal wall for future percutaneous cannulation of the biliary tree in the event of recurrent stones or strictures (a modification of the technique described by Hutson and colleagues1 for the treatment of recurrent biliary strictures in sclerosing cholangitis). The excised specimen contained multiple intrahepatic pigmented stones. The biliary mucosa showed marked chronic inflammatory and fibrotic changes with a minimally inflamed hepatic parenchyma (Fig. 2). FIG. 2. Excised specimen of the left hepatic lobe showing chronic inflammatory and fibrotic changes of the biliary mucosa with minimal inflammation of the hepatic parenchyma.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".